Hypertension is the leading cause of cardiovascular disease and death. Despite increased knowledge of its importance in cardiovascular disease, the worldwide prevalence is still increasing and there is considerable scope for improvement of awareness, treatment and control. In this review, five major issues in hypertension management in secondary prevention of cardiovascular disease will be outlined. The first two issues will address hypertension diagnosis: out-of-office blood pressure measurements and the detection of secondary hypertension. The last three issues will address hypertension treatment: lifestyle modification, medication adherence and blood pressure targets. For each of the five issues, we will outline existing knowledge, gaps in existing knowledge, barriers preventing full implementation of guideline recommendations, and possible solutions to improve management of the current disquieting situation.